Loved Ones -Tell us Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.First and Last NameIs your loved one on a cocktail - a combination of drugs?Did they accumulate disorders and new diagnosis?Example: From anxiety to insomnia to fibromyalgiaSingle Line TextWhich one were they taking?VenlafaxineZoloftPaxilCelexaMirtLexaproCymbaltaOtherCombination aka CocktailWhich antidepressant were they taking?Loved One's Name Who was Lost Too SoonIn Memory of those who are victims of Pharmacide- name and date- so we can raise awareness and know they will not be forgotten.Informed Consent ExperienceWas informed consent given? Were you aware of the dangers? Potential drug induced symptoms? Adverse reactions?Experience as loved oneWas your loved one withdrawn? Accusations of being trapped or controlled?IrritationWas your loved one irritated?Emotionally?Did you know they were (are) spellbound? How did you figure it out? Medically Spellbound: under the control of the drugsFiguring out?What did it feel like to see what the problem was?Advice?What is something you would want other loved ones to know? What do you want other medicated to know?Symptoms?Did you notice Drug induced Symptoms?Personality change?Did you notice changes in personality? - change? Is Tapering?Hyperbolic taperingTapering wiht Dr assistanceTapering with help of groupsCold TurkeyNot TaperingRecoveredTapering experience? Depression?Was your loved one depressed? Has it improved?Shift in thinking?Did you experience a shift in thinking if/when you connected the dots?How are you now?How are you now?Would you like to share your story?YesNoyes, AnonymouslyWhat is one of our favorite resources to navigate this?PhoneWe will contact you via text, with permission. Click to Submit
